GoTo Telemed Launches Comprehensive Restless Legs Syndrome Management Program

Posted on 2026-04-13 by GoToTelemed in Internet & Online // 0 Comments

Helena, Montana, 2026-04-13 — /EPR Network/ — GoTo Telemed, the nation’s leading integrated telehealth ecosystem serving over 10 million patients nationwide , today announced the launch of its comprehensive Restless Legs Syndrome (RLS) Management Program, a dedicated virtual care service designed to address the full spectrum of RLS symptoms through evidence-based diagnostic evaluation, iron management, medication optimization, and lifestyle coaching. Delivered by a network of sleep medicine specialists, neurologists, and primary care physicians, this program brings expert RLS care directly to patients nationwide, aligned with the groundbreaking 2025 American Academy of Sleep Medicine (AASM) clinical practice guidelines.

Restless Legs Syndrome affects approximately 13% of Americans, with prevalence rising to nearly 20% in older adults and up to 80% in pregnant women . The condition is characterized by an irresistible urge to move the legs, often accompanied by unpleasant sensations such as creeping, crawling, tingling, or pulling, which worsen during rest, intensify in the evening, and are temporarily relieved by movement . Despite its high prevalence and significant impact on sleep quality, quality of life, and mental health—patients with RLS experience depression and anxiety at rates four times higher than the general population —access to specialized care remains limited, with long wait times and geographic barriers preventing many from receiving guideline-directed treatment.

“Restless Legs Syndrome is not merely an annoyance—it is a chronic neurological condition that devastates sleep, impairs daytime function, and erodes quality of life. For decades, patients were treated with dopamine agonists, which, while effective in the short term, often made the underlying condition worse over time through a process called augmentation,” said a GoTo Telemed spokesperson. “The new 2025 AASM guidelines represent a paradigm shift, moving decisively away from dopamine agonists toward safer, more effective first-line therapies: iron supplementation and alpha-2-delta ligands. Our RLS Management Program operationalizes these guideline changes, bringing evidence-based, personalized care directly to patients through telehealth—eliminating geographic barriers and ensuring that every individual with RLS receives the right treatment at the right time.”

Paradigm Shift: Moving Away from Dopamine Agonists

The 2025 AASM guidelines mark a major departure from prior standards. Dopamine agonists (pramipexole, ropinirole, rotigotine), previously considered first-line therapy, are no longer recommended for routine use due to the risk of augmentation—a paradoxical worsening of RLS symptoms that occurs in 7% to 10% of patients per year . Over five years of treatment, augmentation affects 35% to 50% of patients, leading to earlier symptom onset, extension of symptoms to the arms and trunk, and increased symptom intensity, often creating a vicious cycle of dose escalation and further worsening . Additionally, dopamine agonists are associated with impulse control disorders, including pathological gambling, hypersexuality, and compulsive shopping, even at the low doses used for RLS .

Prior Standard (Pre-2025) New Standard (2025 AASM Guidelines)
Dopamine agonists (pramipexole, ropinirole, rotigotine) as first-line Gabapentinoids (gabapentin, gabapentin enacarbil, pregabalin) – strong recommendation
Limited emphasis on iron testing Routine serum ferritin and transferrin saturation testing – good practice statement
Iron supplementation rarely prioritized IV iron preferred first-line for severe RLS with ferritin <100 ng/mL or transferrin saturation <20%
Long-term dopamine agonist use accepted despite augmentation risk Dopamine agonists now recommended against for routine use (conditional against)
Iron Supplementation as First-Line Therapy

A cornerstone of the updated guidelines is the recognition that brain iron deficiency plays a central role in RLS pathophysiology. The AASM issued a good practice statement that all patients with clinically significant RLS should undergo regular testing of serum iron studies, including ferritin and transferrin saturation, ideally in the morning after avoiding iron-containing supplements and foods for at least 24 hours . Intravenous iron supplementation is now the preferred first-line treatment for severe RLS, with a strong recommendation for patients whose ferritin is below 100 ng/mL or whose transferrin saturation is below 20% . Oral iron is conditionally recommended for less severe cases . The guidelines explicitly note that iron supplementation targets for RLS are different than for the general population, with a target ferritin above 100 ng/mL considered optimal for symptom control .

Alpha-2-Delta Ligands: The New Pharmacologic Standard

The guidelines provide strong recommendations (moderate certainty of evidence) for three alpha-2-delta calcium channel ligands as first-line pharmacologic therapy: gabapentin enacarbil, gabapentin, and pregabalin . Unlike dopamine agonists, these medications do not cause augmentation and offer additional benefits for patients with comorbid insomnia, chronic pain syndromes, anxiety, or history of impulse control disorders . Clinical trials have demonstrated their long-term efficacy, and the guidelines emphasize starting with low doses and titrating slowly, particularly in older adults or those sensitive to side effects such as dizziness, sedation, or weight gain .

Medication Starting Dose Key Considerations
Gabapentin enacarbil 600 mg daily at 5 PM Long-acting formulation; linear kinetics; FDA-approved for RLS
Gabapentin 300 mg 1-2 hours before bedtime Flexible dosing; titrate to effect; watch for sedation
Pregabalin 75-150 mg daily in late afternoon Also effective for neuropathic pain and anxiety
Comprehensive Diagnostic and Management Protocol

The GoTo Telemed RLS Management Program follows a structured, evidence-based protocol aligned with the four essential diagnostic criteria for RLS established by the International Restless Legs Syndrome Study Group :

Diagnostic Criterion Description
Urge to move An irresistible urge to move the legs, often accompanied by uncomfortable sensations (crawling, creeping, tingling, pulling, aching)
Worsening with rest Symptoms begin or worsen during periods of rest or inactivity (sitting, lying down)
Relief with movement Symptoms are partially or totally relieved by movement (walking, stretching, massaging)
Circadian pattern Symptoms worsen in the evening or at night
Iron Status Evaluation: All patients undergo baseline serum ferritin and transferrin saturation testing, with follow-up testing every 3-6 months. Patients with ferritin below 100 ng/mL or transferrin saturation below 20% receive iron supplementation—intravenous ferric carboxymaltose for moderate-to-severe RLS, oral ferrous sulfate 325 mg with vitamin C for milder cases.

Medication Management: For patients requiring pharmacotherapy, treatment is initiated with gabapentin enacarbil (600 mg daily), gabapentin (starting 300 mg at bedtime), or pregabalin (75 mg daily), titrated based on symptom response and tolerability. Dopamine agonists are reserved only for patients who have failed or cannot tolerate alpha-2-delta ligands, with close monitoring for augmentation.

Lifestyle and Self-Care Strategies

The program incorporates evidence-based lifestyle modifications that are particularly effective for patients with mild RLS or as adjuncts to pharmacotherapy :

Self-Care Strategy Recommendations
Dietary modifications Avoid caffeine, alcohol, and refined sugars; maintain iron-rich diet (red meat, leafy greens, legumes)
Exercise Regular low-to-moderate intensity activity (walking, stretching) during the day; avoid vigorous exercise close to bedtime
Sleep hygiene Consistent sleep-wake schedule; cool, dark, quiet bedroom; relaxation routines (warm bath, reading, meditation) before bed
Symptom relief techniques Leg massage, heating pads or cold packs, vibration pads, stretching exercises before bed
Medication review Identify and address exacerbating medications (antihistamines, certain antidepressants, anti-nausea drugs)
Stress management Yoga, meditation, deep breathing, cognitive-behavioral techniques
Special Populations

The program addresses the unique needs of specific patient populations:

Population Special Considerations
Pregnancy RLS affects up to 80% of pregnant women, typically emerging in the third trimester and resolving postpartum. Iron supplementation is first-line; gabapentinoids should be avoided unless absolutely necessary.
Children Approximately 2% of children meet RLS diagnostic criteria. Iron supplementation (ferritin target >50 ng/mL) and lifestyle modifications are first-line; medication is reserved for moderate-to-severe cases.
Older adults Higher prevalence (up to 20%), increased sensitivity to medication side effects, higher risk of polypharmacy. Lower starting doses and slower titration recommended.
End-stage renal disease RLS prevalence up to 30% in dialysis patients. Gabapentinoids are preferred; dopamine agonists are relatively contraindicated.
Addressing Critical Gaps in RLS Care

The RLS Management Program directly confronts persistent barriers to effective treatment:

Paradigm Inertia: Many providers continue to prescribe dopamine agonists despite guideline changes. The program ensures that all patients receive guideline-aligned first-line therapy.

Iron Underutilization: Iron deficiency is grossly underrecognized as a treatable cause of RLS. The program mandates routine iron testing and appropriate supplementation.

Diagnostic Delays: Patients often suffer for years without a proper diagnosis, attributing symptoms to stress, aging, or other causes. Telehealth eliminates barriers to expert evaluation.

Geographic Access Disparities: Sleep medicine specialists and neurologists are concentrated in academic centers. Telehealth connects patients with RLS experts regardless of location.

Long-term Management Gaps: RLS is a chronic condition requiring ongoing monitoring for symptom control, medication side effects, and augmentation. The program provides continuous, structured follow-up.

Integration Within GoTo Telemed’s Comprehensive Ecosystem

The RLS Management Program operates as a fully integrated component of GoTo Telemed’s unified telehealth platform:

Unified Health Record: All diagnostic assessments, laboratory results, medication histories, and symptom tracking are consolidated in the patient’s lifetime electronic health record.

Iron Status Tracking: Automated alerts for low ferritin or transferrin saturation, with protocol-driven iron supplementation recommendations.

Symptom Monitoring: Digital tools for tracking RLS symptom frequency, severity, and impact on sleep, with automated trend analysis and clinical alerts.

Medication Management: E-prescribing for gabapentinoids and iron preparations, with automated refill reminders and adherence monitoring.

Seamless Care Coordination: Warm handoffs to sleep medicine specialists, neurologists, and mental health providers for complex cases or comorbid conditions.

Availability

GoTo Telemed’s Restless Legs Syndrome Management Program is available immediately to patients nationwide through the GoTo Telemed platform. Patients may enroll directly or be referred by their primary care provider.

Sleep medicine specialists, neurologists, and primary care physicians interested in joining GoTo Telemed’s provider network are invited to apply through the company’s credentialing portal.

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